Outlook 2014: Construction/Design

Florida Hospital's expansion into the Orlando suburb of Winter Park is starting with a free-standing emergency department with imaging facilities and doctors' offices. It's design to grow into a full hospital if demographic and market forces warrant it.

The focus in healthcare construction in 2014 will be on outpatient facilities as well as on expanding and upgrading existing hospitals. In building those facilities, there is growing interest in designs that reflect changes in healthcare delivery and payment, including a greater need for flexible use.

Henry Chao, healthcare design director for the architectural firm HOK in New York, said healthcare providers increasingly are interested in large medical office buildings that house multiple medical specialties, and are located on university campuses. That's a design model pioneered more than a decade ago by Johns Hopkins University and the Mayo Clinic.

That model allows a patient to receive care for multiple conditions in one place, Chao said. On the business side, this arrangement is better organized for success when reimbursement comes in the form of either capitation or bundled payment.

In other markets, providers are considering outpatient facilities designed for possible future growth into a full hospital, said Kevin Harney, senior project designer with Earl Swensson Associates in Nashville. The facilities begin with a free-standing emergency department and may include an imaging unit, ambulatory surgery capabilities, and a medical office building. The facilities can expand to include inpatient care if an organization gains a strong foothold in a growing market.

Outlook 2014

For architects, their innovation and thought goes into designing a “plug and play” infrastructure that allows existing departments to remain open and operating while the facility builds additional components.

“There aren't many, if any, new hospitals on the (drawing) board,” Harney said. Instead, organizations are examining their existing facilities and looking at “how they can do things more efficiently with the existing chassis.”

The uncertainty over what healthcare will look like in the future means that facilities are being designed for maximum flexibility. “To custom-build anything for healthcare is a pretty big gamble,” Chao said.

Chao said some architects are working on large residential community developments anchored by a hospital. After the hospital is built, a hotel is usually next in the master plan. After that is a residential community designed to promote exercise and healthy living.

“As a healthcare architect, it used to be that I needed to know the regulations on how wide a hospital corridor had to be,” he said. “Now I also need to know the widths of the sidewalks.”